Original - Court 1st copy - Plaintiff 2nd copy - Defendant 3rd copy - Friend of the court Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY ORDER REVOKING RELEASE AND FORFEITING BOND, NOTICE OF INTENT TO ENTER JUDGMENT (DOMESTIC RELATIONS) CASE NO. Court address Court telephone no. Defendant's name, address, and telephone no. Plaintiff's name, address, and telephone no. v Attorney: Attorney: TO: (Name and address of payer.) (Name and address of surety or other depositor posting bond.) ORDER The payer has violated the conditions of bond as described below. Face amount or value of bond Amount deposited $ $ TYPE OF BOND: Cash Surety IT IS ORDERED the release is revoked and bond is forfeited. The proceeds of the bond shall be disposed of as ordered by the court in its judgment after bond forfeiture. Date Judge Bar no. NOTICE TO THE PAYER AND SURETY: The payer has 28 days from the date of this order to surrender to the court or to satisfy the court that there was compliance with the conditions of release/bond, or that compliance was impossible through no fault of the payer. Otherwise, judgment in the full face amount or value of the bond, plus costs, will be entered against the payer or any surety or other depositor. Money or other security on deposit will be used toward payment of the judgment. A warrant for payer's arrest/order to apprehend has been will be issued. CERTIFICATE OF MAILING I certify that on this date I served a copy of this order on the parties or their attorneys by first-class mail addressed to their last-known addresses as defined in MCR 2.107(C)(3). Date CC 88 (3/08) Clerk of the court/Deputy ORDER REVOKING RELEASE AND FORFEITING BOND, NOTICE OF INTENT TO ENTER JUDGMENT (DOMESTIC RELATIONS) MCR 3.221(J)(2) American LegalNet, Inc. www.FormsWorkflow.com